Health Guide Complaints

Health Guide Ranking	Utilization Review Requests, Decisions, and Appeals	Independent External Review
Health Guide Complaints	Health Guide Contacts	Health Guide

Four performance areas are presented in this Interactive Guide. Select from the toolbar above to view each of the comparative charts. Below each chart is a description on how to read and understand the results.

Complaints Received by the Company (January 2006 - December 2006)
Insurer/HMO	Total Number of Covered Persons	Number of Complaints Received from Covered Persons	Number of Complaints that were Decided in Favor of the Covered Person after a Review and the Reversal Rate (see explanation below)
Aetna Health, Inc.	47,722	355	76	21%
Anthem Health Plans of Maine, Inc.	361,994	1,396	258	18%
CIGNA HealthCare of Maine, Inc.	13,526	243	80 (includes 7 partial reversals)	33%
Connecticut General Life Insurance Co	57,040	197	74 (includes 1 partial reversal)	38%
Guardian Life Insurance Co of America	30	1	1 partial reversal	50%
Harvard Pilgrim Health Care	21,420	52	22	42%
John Alden Life Insurance Company	445	0	0	0
MEGA Life & Health Insurance Company	8,277	24	10	42%
Securian Life Insurance Co (Dental Coverage Only)	14,980	19	0	0
Trustmark Life Insurance Company	496	0	0	0
United Healthcare Insurance Company	22,950	3	1	33%

COMPLAINTS RECEIVED BY THE COMPANIES

A complaint is a written complaint against an insurer. The complaint may be filed by the person who is covered under the health insurance plan or by someone else on behalf of the insured person.

Please note: The chart above shows complaints received by the insurer where the covered person (or someone on behalf of the covered person) was not happy with a decision of the insurer/HMO. The Reversal Rate is the percentage of insurer/HMO decisions that were made against the covered person and then were reversed after another review. For example, a 50% reversal rate shows that in 5 out of 10 complaints received, the insurer/HMO changed its initial adverse decision in favor of the covered person.

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